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��i � <br /> ' BACKWA7ER PREVENTION DEVIGE PROGRAM <br /> Our records indicate that a backwater prevention device must be installed on your <br /> sewer conneclion to compiy with the new ordin,ance. Please help us verify thal our <br /> informalion is correct by answering.lhe f<:IloWing,questions,about your property: <br /> Do you have a basement? Yes ❑ No '" .• <br /> � �'^ <br /> If yes,does it have plumbing fixtures (sink,toilet, iloor drain, etc.)? Yes � No ❑ <br /> Do you have a backwaler vaive on your sewer line? Ye�No ❑ Don't Know ❑ <br /> Do you have a grinder pump in your basement? Yes ❑ No � Don't Know ❑ <br /> Name: 1 /C/V �-1 �� C �` �� <br /> Property address: '� I � �u�"� C.�' <br /> 1'Phone 1:UZ�� J�+� ' /�V 0 Phone 2: <br /> Email: �� ' (�l �,� �G C..V✓`Cwl� � �� - <br /> I :i�•,:� , . <br /> i��:loE11i���.��41iL�t�t'�i!1����� f:�ri�;'"�L'�il;�ii,6:@ <br /> -- ------ -- _ —. __ - -- - -- — ----y'------- <br />